New WHO Reports
Kayleen Katene, Director of Policy, Mental Health Foundation
Finally
a book about concepts, evidence and practices to promoting mental
health that sheds light on the questions posed to many practitioners
about what mental health promotion is, and how to promote mental
health. ‘Promoting Mental Health: Concepts, Emerging Evidence,
Practice’ is the collaborative work of the University of
Melbourne, the World Health Organisation and Victoria Health that
brings to life the mental health dimension of health promotion.
The Summary Report was released at the International Union for
Health Promotion and Education in Melbourne in April of this year.
The Summary Report is a compulsory read for anyone who is serious about improving mental health; mental health promotion practitioners, policy makers and planners in health and non health sectors of government, education, labour, justice, transport, environment, housing, welfare and businesses whose decisions affect mental health in ways that they may not realise.
The premise of the book is that mental health promotion is part of a larger field of health promotion and sits alongside the prevention of mental disorders and the treatment and rehabilitation of people with mental illnesses and disabilities. Like health promotion, mental health promotion involves actions that support people to adopt and maintain healthy lifestyles and create supportive living conditions or environments for health. The Summary Report describes the concepts relating to promotion of mental health, the emerging evidence for effectiveness of interventions, and the public health policy and practice implications.
The Report is succinct and pithy. The key messages and recommendations highlighted at the beginning and end make it easy for policy makers and planners to engage with the document and its implications for their work. The key messages of the book and recommendations are outlined below.
"There is no health without mental health
The World Health Organization (WHO) defines health as: “... a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO 2001, p.1).Mental health is clearly an integral part of this definition. The goals and traditions of public health and health promotion can be applied just as usefully in the field of mental health as they have been in heart health, infectious diseases, and tobacco control.
Mental health is more than the absence of mental illness: it is vital to individuals, families and societies
Mental health is described by WHO as: “... a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” (WHO 2001, p.1).In this positive sense mental health is the foundation for well-being and effective functioning for an individual and for a community. This core concept of mental heath is consistent with its wide and varied interpretation across cultures.
Mental health is determined by socioeconomic and environmental factors
Mental health and mental illnesses are determined by multiple and interacting social, psychological, and biological factors, just as health and illness in general are. The clearest evidence for this relates to the risk of mental illnesses, which in the developed and developing world is associated with indicators of poverty, including low levels of education, and in some studies, with poor housing and low income. The greater vulnerability of disadvantaged people in each community to mental illnesses may be explained by such factors as the experience of insecurity and hopelessness, rapid social change, and the risks of violence and physical ill-health.Mental health is linked to behaviour
Mental, social, and behavioural health problems may interact so as to intensify their effects on behaviour and well-being. Substance abuse, violence, and abuses of women and children on the one hand, and health problems such as heart disease, depression, and anxiety on the other, are more prevalent and more difficult to cope with in conditions of high unemployment, low income, limited education, stressful work conditions, gender discrimination, unhealthy lifestyle, and human rights violations.Mental health can be enhanced by effective public health interventions
The improvement in heart health in several countries has had more to do with attention to environment, tobacco, and nutrition policies than with specific medicines or treatment techniques. The malign effects of changing environmental conditions on heart health have been reversed to varying extents by actions at multiple levels. Similarly, research has shown that mental health can be affected by non-health policies and practices, for example in housing, education, and child care. This accentuates the need to assess the effectiveness of policy and practice interventions in diverse health and non-health areas. Despite uncertainties and gaps in the evidence, we know enough about the links between social experience and mental health to make a compelling case to apply and evaluate locally appropriate policy and practice interventions to promote mental health.Collective action depends on shared values as much as the quality of scientific evidence
In some communities, time-honoured practices and ways of life maintain mental health even though mental health may not be identified as the outcome, or identified by name. In other communities, people need to be convinced that making an effort to improve mental health is realistic and worthwhile.A climate that respects and protects basic civil, political, economic, social, and cultural rights is fundamental to the promotion of mental health
Without the security and freedom provided by these rights it is very difficult to maintain a high level of mental health.Intersectoral linkage is the key for mental health promotion
Mental health can be improved through the collective action of society. Improving mental health requires policies and programmes in government and business sectors including education, labour, justice, transport, environment, housing, and welfare, as well as specific activities in the health field relating to the prevention and treatment of ill-health.Mental health is everybody’s business
Those who can do something to promote mental health, and who have something to gain, include individuals, families, communities, commercial organisations, and health professionals. Particularly important are the decision-makers in governments at local and national levels whose actions affect mental health in ways that they may not realise. International bodies can ensure that countries at all stages of economic development are aware of the importance of mental health to community development. They can also encourage them to assess the possibilities and evidence for intervening to improve the mental health of their population."
WHO (2004) Promoting Mental Health: Concepts, Emerging Evidence, Practice: Summary Report, (pp. 10-11).
Key Recommendations
The key recommendations from the Summary Report are:
- the promotion of mental health can be achieved by effective public health and social interventions
- intersectoral collaboration is the key to effective interventions for mental health promotion
- sustainability of programmes is crucial to their effectiveness
- continue to build the evidence base and international action to generate and disseminate further evidence.
The Report then emphasises that mental health is a community responsibility, not just an individual concern, just as many countries and communities have realised for heart health, tobacco control, dental health, and in other areas. The social and economic costs of poor mental health are high and the evidence suggests that they will continue to grow without community and government action.
Conclusions
In New Zealand, we need to come together as policy advisors, planners, funders and practitioners to look at the evidence and implications of these recommendations and then plan how we can move forward together. As well as using the evidence in the Summary Report, we can also add to it with unique indigenous models to improve health and wellness of whanau, hapu and iwi.
A strength of the Report is the collaboration of a range of contributors
outside the health sector as within the sector. Congratulations
to the editors Helen Herrman, Shekhar Saxena and Rob Moodie and
all the contributors. This Summary Report and the Full Report is
a huge step forward to creating a better understanding of the importance
of promoting mental health, and connecting those in the mental
health sector and other sectors who need to endorse and assist
the promotion of mental health while continuing to deliver services
for people living with mental illnesses.
WHO will be launching the report of ‘Promoting Mental Health: Concepts, Emerging Evidence, Practice’ at the 3rd World Conference on the Promotion of Mental Health and the Prevention of Mental and Behavioural Disorders in Auckland on 15-17th September, 2004.
This report complements the work of another major WHO project, which focuses on the evidence for prevention of mental disorders. This summary report ‘Prevention of Mental Disorders: Effective Interventions and Policy Options’ will also be released at the conference along with ‘Mental Health Promotion: Case Studies from Countries’, a report of 35 promotion case studies from around the world (a joint publication from the World Federation of Mental Health and WHO).
